Gastrostomy (G-) and gastro-jejunal (G-J) feeding tubes are placed in infants and children who refuse to eat or are unable to eat enough to sustain normal growth due to a variety of medical reasons: neurological disease, heart defects, and genetic disorders, among others. Although often intended as temporary, short-term solution to medical complications, feeding tubes can become a permanent conduit for enteral nutrition. While tube feeding routinely saves the lives of children who exhibit chronic oral food refusal, long-term continuation of tube feeding creates a significant financial, psychological, and emotional burden to patients, caregivers, and families. Making the transition to oral feeding is crucial for children to achieve their full potential for a healthy and productive life. The purpose of this application is to investigate the effectiveness of a 24-week outpatient multidisciplinary treatment using amitriptyline to treat pain in young children in order to transition from gastrostomy feeding to oral feeding. PUBLIC HEALTH RELEVANCE: Improved preterm infant survival has increased the prevalence of feeding problems in older infants and toddlers and severe feeding problems occur in over half of children with chronic medical conditions. As the prevalence of gastrostomy tube feeding has increased, so have the challenges associated with transitioning a child from tube to oral feeding. Achieving the transition from tube to oral feeding is critical for children to reach their full potential of a healthy and productive life.